Magnetic resonance imaging of ruptured aneurysm of the ascending aorta

Magnetic resonance imaging (MRI) has been recognized as an excellent method to assess pathology of the thoracic aorta (Amparo et al, 1985; Geisinger et al, 1985; Glazer et al, 1985; Dinsmore et al, 1986). However, it is generally not feasible in the investigation of acute complications of aortic disease, because the strength of the magnetic field and the restricted access to the patient during the investigation preclude adequate monitoring and therapy in most instances. In this paper, the case of a ruptured aortic aneurysm is presented, which was imaged a few hours after the onset of symptoms. Although the patient was haemodynamically stable at the time of the examination, she died 2h after the procedure, before surgery could be performed. A postmortem examination was obtained, and the findings were compared with the magnetic resonance images. An 80-year-old woman was admitted to our hospital within 1 h of the onset of severe chest pain. Blood pressure values were in the lower normal range, although there was a long history of arterial hypertension. Myocardial infarction was excluded by electrocardiogram (ECG) and enzyme examination. The physical examination revealed a diastolic heart murmur suggestive of incompetence of the aortic valve. A plain radiograph of the thorax showed abnormal widening of the mediastinum. On subsequent two-dimensional echocardiography, aneurysm of the ascending aorta and some pericardial fluid were recognized.